(626) 584-6303 Pasadena, CA

Earthquake Insurance Quote

Earthquake Insurance Quote

 
Policy Holder
Contact Name*
Email*
Phone Number*
Date of Birth*
Occupation
Property Location
Address
City
State
Zip Code*
County
Current Homeowner Insurance Information
Company Name
Current Coverage A Dwelling Replacement Value (cost to rebuild)
Expiration Date
Insurance Information
Deductible Desired:  It is a percentage of your coverage amount.

Dwelling Information
Is this home owner occupied or a rental?  
Estimated Replacement Cost (Coverage A on your home policy)
Square Footage
Year Constructed
Is Your Home over 20 Years Old? If so, What Updates Have Been Made?
Age of Hot Water Heater?
Roof Type and Age?
How Many Floors (Stories)?




Type of Construction




Foundation
(check all that apply)		 Slab




Located within 5 miles of Fire Station
Located 1000 feet from Fire Hydrant
Claims
Any existing damage to your house?

Personal Property
Estimated value of your personal property:
Jewelry & Watches
Furs
Silver
Firearms
Stamp and Coin Collections
Fine Arts and Breakable Items
* = Required Field